Ooh, baby

Women & Infants receives OK for its Certificate of Need to renovate its birthing facility

Photo by Richard Asinof

On July 24, the R.I. Department of Health approved the request by Women & Infants Hospital to receive a Certificate of Need to renovate its existing birthing facility.

By Richard Asinof

Posted 7/31/17

Why is this story important?

The decision by the R.I. Department of Health to approve the Certificate of Need for Women & Infants Hospital to renovate its existing obstetrics facility somehow got lost in the coverage of changes in corporate leadership at Care New England.

The questions that need to be asked

How will the decision by R.I. DCYF to look at sleeping arrangements for infants as a way to prevent deaths be integrated into the ongoing opportunities for education around parenting at Women & Infants? Does the decision to grant the Certificate of Need for renovations at Women & Infants effectively close the door on plans by Lifespan to build its own obstetrics facility? Will issues around environmental justice become part of the community needs discussion around health equity zones? What kinds of interventions around healthy housing can become integrated into discussions around how to limit risk to mothers and their babies? Is there an opportunity to revisit toxic stress as an important indicator of wellness for young mothers and fathers, as well as post-partum depression?

Under the radar screen

In the debate over Trumpcare vs. Obamacare, the decision by Majority Leader Sen. Mitch McConnell to exclude Republican women senators from the discussions around how to shape the health care legislative agenda revealed a fundamental flaw in strategy: the sexist, misogynistic approach to health care backfired.
Both Maine Sen. Susan Collins and Alaska Sen. Lisa Murkowski have found themselves enjoying increased support from their constituents, despite attempts by President Trump and his surrogates to bully them.
The reality is that just like Voldemort, who in his final battle with Harry Potter, failed to recognize that his wand could no longer perform as it once did, there is a similar kind of impotence that has settled over the President Donald Trump and his aides. The shriller the tweets, the more nefarious the personal insults, the more impotent Trump appears.
That, of course, poses a real danger for the nation: how desperate will Trump become as his impotence becomes more transparent and his need for adoration grows?

PROVIDENCE – The dynamics of covering the news is that everyone seems to be in search of that bright, shiny object that keeps disappearing, only to have it reappear the next moment, fluttering near the crime scene tape at yet another scene of murder, mayhem and scandal.

Back in 1965, Frank Zappa and the Mothers of Invention captured the ethos of the news machine in Trouble Every Day:

You know I watched that rotten boxUntil my head begin to hurtFrom checkin’ out the wayThe newsmen say they get the dirtBefore the guys on channel so-and-so

And further they assertThat any show they’ll interruptTo bring you news if it comes upThey say that if the place blows upThey will be the first to tell,Because the boys they got downtownAre workin’ hard and doin’ swell,And if anybody gets the newsBefore it hits the street,They say that no one blabs it fasterTheir coverage can’t be beat

Translated, the news machine often gets lost in covering the symptoms, not the disease.

Buried in the news that Mark Marcantano, the president and COO of Women & Infants Hospital, had resigned his position, effective July 28, was a perhaps a far more important and newsworthy development: on July 24, the R.I. Department of Health accepted the report of R.I. Health Services Council and approved a Certificate of Need allowing Women & Infants Hospital to renovate its existing 20-bed birthing obstetrics facility.

Three conditions were attached to the Certificate of Need:

• First, Women & Infants was to “direct resources to support the local Health Equity Zones community action plans priorities and strategies

• Second, Women & Infants Hospital needed to submit its existing community benefit plan and its Community Health Needs Assessment to the R.I. Department of Health within one month of the July 24 decision

• Third, at the request of the R.I. Department of Health, Women & Infants Hospital was to provide an analysis identifying its progress toward achieving the local HEZ Community Action Plan’s priorities and strategies.

There is a lot to unpack in the decision and the conditions attached.

The trees for the forestWhatever the reasons for Marcantano’s departure, and despite the musings by some news analysts to read the tea leaves about what it portends about Care New England’s potential merger with Partners Healthcare, such as what WPRI’s Ted Nesi wrote in his July 29 column, “As one health care expert noted to me, though, Care New England could be clearing the decks so Partners can put its own people in place,” the decision to grant Women & Infants its Certificate of Need has perhaps larger implications within the struggle between Care New England and Lifespan.

It appears to dampen the likelihood that the R.I. Health Services Council will approve a Certificate of Need for Lifespan’s Rhode Island Hospital to build a new $43 million obstetrics facility a few hundred yards away from Women & Infants Hospital.

Marcantano had led the effort by Women & Infants to gain approval – as noted in the letter from Care New England President and CEO Dennis Keefe to hospital staff announcing Marcantano’s resignation: “Just this week the Department of Health gave its final approval to the certificate of need application paving the way for much-needed birth center renovations. Mark orchestrated this effort to great success.”

[Of course, you wouldn’t know about the approval of the Certificate of Need for the renovation of the obstetrics facility if you read the news article in The Providence Journal, which did not cover it in its story about the announcement that Marcantano was leaving.]

Health equityThe conditions placed on the approval for the Certificate of Need reveal a more fascinating undercurrent in health care that often gets ignored by most news coverage: the fact that 85 percent to 90 percent of what impacts health care outcomes has little to do with what occurs in a doctor’s or nurse’s office. Under the leadership of Ana Novais and Dr. Nicole Alexander-Scott, the R.I. Department of Health has championed the effort in 10 Rhode Island communities to develop health equity zones, addressing the social and economic disparities of health care.

Linking the work of Women & Infants Hospital, where some 85 percent of all babies are born to Rhode Island mothers, with the efforts of local health equity zones is a powerful tool to improve the pre-natal and post-natal health of mothers and their children.

And, by asking Woman & Infants Hospital to make transparent its community needs assessment required by federal law, it allows for a kind of public conversation around what the future role of a health system should be in its interactions with the community and its needs.

What’s at stakeA more fundamental conflict, often lost in the discussion over the future of health care in America, Trumpare vs. Obamacare, reflects the future role of the hospital-driven health care system vs. the role that communities and patients will play in the decision-making.

Those viewpoints are reflected in the positions staked out by Sen. Sheldon Whitehouse and Christine Ferguson, health care consultant. [See articles in this week’s ConvergenceRI.]

Whitehouse dismissed the idea of health equity as a provident idea, saying the focus needed on how to save and improve the system we currently have.

“I think you have to come at [the problems with health care] of making the system work better for people, rather than just adding more expense and activity to a system that isn’t working better for people,” Whitehouse said.

Ferguson, who helped shape the original health care reform bill under Gov. Mitt Romney in Massachusetts, which served as a prototype for the Affordable Care Act, described the issue of markets:

“From my perspective, one thing I see is that when you talk to people who are in leadership roles, it’s clear that the people who are at the table making decisions trying to come with new ways to deal with the old problems have never paid more than 20 percent toward premiums and co-payments,” Ferguson said.

Ferguson also said that there was a divide between what news reporters paid for their share of health care costs compared with normal people, skewing their understanding of the problem.